Hypersensitivity to cefepime, other cephalosporins, penicillins, other beta-lactam antibiotics, or any component of the formulation

Warnings / Precautions Drug

Concerns related to adverse effects:• Elevated INR: May be associated with increased INR, especially in nutritionally-deficient patients, prolonged treatment, hepatic or renal disease.• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.Disease-related concerns:• Gastrointestinal disease: Use with caution in patients with a history of gastrointestinal disease, especially colitis.• Renal impairment: Use with caution in patients with renal impairment (Clcr ≤60 mL/minute); dosage adjustments recommended. May increase risk of encephalopathy, myoclonus, and seizures. • Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.

Interactions

BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combinationProbenecid: May increase the serum concentration of Cephalosporins. Risk C: Monitor therapyTyphoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 24 hours after cessation of antibacterial agents. Risk D: Consider therapy modification

Pregnancy

B Pregnancy Implications Teratogenic effects were not observed in animal studies; therefore, cefepime is classified as pregnancy category B. It is not known if cefepime crosses the human placenta.

Lactation

Enters breast milk/use cautionBreast-Feeding Considerations Small amounts of cefepime are excreted in breast milk. The manufacturer recommends that caution be exercised when administering cefepime to nursing women. Nondose-related effects could include modification of bowel flora.

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysis and murein hydrolases) while cell wall assembly is arrested.